2021年 · 第101卷第22期

Sleep is an important physical function of human body, which is vital to human health. The impact of sleep duration and sleep quality on health outcomes has received considerable attention in recent years. To assess independent risk factors for sleep length, as well as poorer sleep characteristics associated with cardiovascular disease, cancer, and mortality, the researchers conducted a prospective cohort study with a median mean follow-up length of 8.57 years. A total of 407,500 UK adults aged (55.99 ± 8.10) years and 53.93% female were included in the study. Adjusted hazard ratios (HR) for the association of sleep duration and sleep quality with cardiovascular disease, cancer, and mortality were calculated by the Cox proportional hazards model. The results showed that the risk of all-cause death (HR =1.25, 95% CI: 1.16-1.34; HR =1.30, 95% CI: 1.22-1.38), cardiovascular disease death (HR =1.27, 95% CI: 1.09-1.49; HR =1.32, 95% CI: 1.16-1.50) and cardiovascular disease onset (HR =1.23, 95% CI: 1.16-1.31; HR =1.08, 95% CI: 1.02-1.15) were higher in the population with sleep duration ≤5 h and ≥9 h compared with those with sleep duration 7 h. In addition, the risk of cancer death (HR =1.19, 95% CI: 1.10 to 1.30) and cancer development (HR =1.08, 95% CI: 1.04 to 1.12) were higher in people who slept for ≥9 h. Moreover, the incidence of cardiovascular disease was significantly associated with snoring, insomnia, and narcolepsy, with increased risks of 7%, 26%, and 20%, respectively. It can be seen that both long and short sleep can increase the risk of a series of adverse health consequences. Therefore, it is recommended to sleep for 7 to 8 hours a day. In addition, people at high risk of cardiovascular disease should be more vigilant about snoring, insomnia and narcolepsy. The above findings can further support sleep medicine research, disseminate and promote sleep hygiene knowledge to more people, thereby reducing the mortality and morbidity of related diseases

Obstructive sleep apnea (OSA) is a recurrent interruption of airflow in patients during sleep, lasting at least 10 s. Intermittent hypoxia caused by apnea is associated with cerebral cortical micro-arousal and decreased blood oxygen saturation. Clinically, OSA patients can be manifested as snoring, loud and irregular snoring, often suffocating or waking up at night, sleep rhythm disorder, dry mouth in the morning, dizziness, daytime drowsiness, memory loss, cognitive function decline and behavioral abnormalities in severe cases. In the United States, approximately 25% of adults have OSA. OSA is the leading cause of excessive sleepiness in patients and is associated with decreased quality of life, reduced productivity at work, and increased risk of motor vehicle accidents. More and more studies have shown that OSA is closely related to the increased incidence and mortality of hypertension, type 2 diabetes, atrial fibrillation, heart failure, coronary heart disease, stroke. Most patients with OSA can be diagnosed by a portable home sleep apnea monitoring device (HSAT), and its monitoring sensitivity is about 80%. Effective treatments for OSA include weight loss, physical exercise, continuous positive airway pressure therapy (CPAP), oral appliances and surgical treatment, and hypoglossal nerve stimulation therapy for BMI<32 kg/m2 Patients are effective. At present, there is no effective drug treatment for OSA. CPAP treatment can reduce blood pressure in patients with OSA, especially in patients with refractory hypertension. However, clinical randomized controlled trials have shown that CPAP treatment does not significantly reduce the incidence and mortality of cardiovascular and cerebrovascular events in OSA patients. This review comprehensively searched OSA-related articles included in Pubmed and Cochrane from January 2010 to February 2020, focusing on randomized controlled trials, systematic reviews, meta-analyses and clinical practice guidelines, and comprehensively elaborated the latest research progress in epidemiology, pathophysiology, diagnostics and treatment measures of OSA.

Narcolepsy is a sleep disorder characterized by the loss of hypocretin-1 neurons in the lateral hypothalamus and is associated with metabolic disorders. Despite extensive studies of metabolic alterations in patients with narcolepsy, the results remain controversial. To determine the metabolic profile of patients with narcolepsy, the researchers searched the main clinical databases PubMed and Scopus for literature related to narcolepsy metabolism until November 2, 2020, and conducted a systematic review and meta-analysis of the included literature. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) Literature Quality Evaluation Scale, combined effect sizes by fixed-effects models or random-effects models, heterogeneity of studies was measured by I2 index and Q-test, and publication bias was measured by funnel plots. Subgroup analysis and meta-regression analysis of potential moderators were performed to measure the effect of confounders on effect size. A total of 48 articles were included, and the age of the included population was 11.66 to 71.86 years old. The results showed that compared with the control group, the prevalence of obesity in narcolepsy patients (log OR =0.93, 95% CI: 0.73-1.13, P<0.001), diabetes prevalence (log OR =0.64, 95% CI: 0.34-0.94, P<0.001), prevalence of hypertension (log OR =0.33, 95% CI: 0.11-0.55, P<0.001) and the incidence of dyslipidemia (log OR =1.19, 95% CI: 0.60-1.77, P<0.001) is higher. In addition, narcolepsy had higher BMI (SMD =0.50, 95% CI: 0.32-0.68, P<0.001), thicker waist circumference (SMD =8.61, 95% CI: 2.03 to 15.19, P =0.01), and higher plasma insulin levels (SMD =0.61, 95% CI: 0.14 to 1.09, P =0.01). However, fasting blood glucose, basal metabolic rate-resting metabolic rate (BMR-RMR), systolic blood pressure, diastolic blood pressure, cerebrospinal fluid melanin concentrate hormone, serum growth hormone, plasma, and cerebrospinal fluid leptin were not significantly different in patients with narcolepsy compared with controls. Therefore, early screening of narcolepsy patients for metabolic alterations and cardiovascular risk factors is necessary, so as to reduce the morbidity and mortality of metabolic and cardiovascular diseases.

Crohn's disease (CD) is a chronic intestinal injury disease. In recent years, under the premise of widespread use of immunosuppressants and biologics, half of patients still have to be operated within 10 years after diagnosis. However, surgery cannot cure CD, and how to prevent postoperative recurrence is still a hot topic at present. Ustenumab is a humanized IgG1 κ monoclonal antibody that is a p40 protein subunit antagonist of interleukin (IL) -12 and IL-23. Previous studies have shown that ustenumab is more effective than placebo in inducing and maintaining clinical or endoscopic remission in patients with moderate to severe CD; However, it has not been clearly suggested that it can effectively prevent postoperative recurrence of CD. To compare the effectiveness of ustenumab and azathioprine in preventing endoscopic recurrence after CD surgery, the study included nine inflammatory bowel disease (IBD) centers and retrospectively analyzed 32 patients treated with ustenumab and 31 patients treated with azathioprine after CD surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥ i2 at 6 months postoperatively. The results of this study showed that the endoscopic recurrence rate in the ustenumab-treated group at 6 months postoperatively was lower than that in the azathioprine-treated group (28.0% vs. 54.5%, P =0.029), that is, ustenumab is more effective than azathioprine in preventing endoscopic recurrence after CD surgery.